Patient and health care professional decision-making to commence and withdraw from renal dialysis: A systematic review of qualitative research

Background and objectives. To ensure decisions to start and stop dialysis in end stage kidney disease are shared, the factors that affect patients and healthcare professionals in making such decisions need to be understood. This systematic review aims to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, and measurements. Medline, Embase, CINAHL and PsychINFO were searched for qualitative studies of factors that affect patients’ and/or healthcare professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results. Of 494 articles screened, 12 studies (conducted: 1985-2014) were included. These involved 206 predominantly haemodialysis patients and 64 healthcare professionals (age range: patients 26-93; professionals 26-61 years). (i) Commencing dialysis: patients based their choice on ‘gut-instinct’ as well as deliberating the impact of treatment on quality-of-life and survival. How individuals coped with decision-making was influential, some tried to take control of the problem of progressive renal failure, whilst others focussed on controlling their emotions. Healthcare professionals weighed-up biomedical factors and were led by an instinct to prolong life. Both patients and healthcare professionals described feeling powerless. (ii) Dialysis withdrawal: Only after prolonged periods of time on dialysis, were the realities of life on dialysis fully appreciated and past choice questioned. By this stage however patients were physically treatment dependent. Similar to commencing dialysis, individuals coped with treatment withdrawal in a problem or emotion-controlling way. Families struggled to differentiate choosing versus allowing death. Healthcare teams avoided and queried discussions regarding dialysis withdrawal. Patients however missed the dialogue they experienced during pre-dialysis education. Conclusions. Decision-making in end stage kidney disease is complex, dynamic, and evolves over time and towards death. The factors at work are multi-faceted and operate differently for patients and health professionals. More training and research on open-communication and shared decision-making is needed

Convergence rates in expectation for Tikhonov-type regularization of Inverse Problems with Poisson data

In this paper we study a Tikhonov-type method for ill-posed nonlinear operator equations \gdag = F( ag) where \gdag is an integrable, non-negative function. We assume that data are drawn from a Poisson process with density t\gdag where $t>0$ may be interpreted as an exposure time. Such problems occur in many photonic imaging applications including positron emission tomography, confocal fluorescence microscopy, astronomic observations, and phase retrieval problems in optics. Our approach uses a Kullback-Leibler-type data fidelity functional and allows for general convex penalty terms. We prove convergence rates of the expectation of the reconstruction error under a variational source condition as $t\to\infty$ both for an a priori and for a Lepski{\u\i}-type parameter choice rule

Results of a sub-scale model rotor icing test

A heavily instrumented sub-scale model of a helicopter main rotor was tested in the NASA Lewis Research Center Icing Research Tunnel (IRT) in September and November 1989. The four-bladed main rotor had a diameter of 1.83 m (6.00 ft) and the 0.124 m (4.9 in) chord rotor blades were specially fabricated for this experiment. The instrumented rotor was mounted on a Sikorsky Aircraft Powered Force Model, which enclosed a rotor balance and other measurement systems. The model rotor was exposed to a range of icing conditions that included variations in temperature, liquid water content, and median droplet diameter, and was operated over ranges of advance ratio, shaft angle, tip Mach number (rotor speed) and weight coefficient to determine the effect of these parameters on ice accretion. In addition to strain gage and balance data, the test was documented with still, video, and high speed photography, ice profile tracings, and ice molds. The sensitivity of the model rotor to the test parameters, is given, and the result to theoretical predictions are compared. Test data quality was excellent, and ice accretion prediction methods and rotor performance prediction methods (using published icing lift and drag relationships) reproduced the performance trends observed in the test. Adjustments to the correlation coefficients to improve the level of correlation are suggested

The Optimum Age and Readiness for Baptism of Adolescents

Eleven baptismal candidates from twelve to fifteen years were studied corporately and individually over seven months in their normal church activities and baptismal class. During this process sociograms were drawn of baptismal classes and questionnaires were developed and administered. Evaluation of candidates was extrapolated from this objective and subjective data

Forestry Club 1987-1988

The numbers of forestry majors has been declining in recent years. One impact of this decline is reflected in the numbers of people in the Forestry Club; however, persons active in club affairs have input enough effort to pull off an extremely successful season

Model rotor icing tests in the NASA Lewis icing research tunnel

Tests of a lightly instrumented two-bladed teetering rotor and a heavily instrumented sub-scale articulated main rotor were conducted in the NASA Lewis Research Center Icing Research Tunnel (IRT) in August 1988 and September and November 1989. The first was an OH-58 tail rotor which had a diameter of 1.575 m and a blade chord of 0.133 m, and was mounted on a NASA designed test rig. The second, a four bladed articulated rotor, had a diameter of 1.83 m with 0.124 m chord blades specially fabricated for the experiment. This rotor was mounted on a Sikorsky Aircraft Powered Force Model, which enclosed a rotor balance and other measurement systems. The models were exposed to variations in temperature, liquid water content, and medium droplet diameter, and were operated over ranges of advance ratio, shaft angle, tip Mach number (rotor speed), and weight coefficient to determine the effect of these parameters on ice accretion. In addition to strain gage and balance data, the test was documented with still, video, and high speed photography, ice profile tracing, and ice molds. Presented here are the sensitivity of the model rotors to the test parameters and a comparison of the results to theoretical predictions

Fall Forestry Welcome Picnic

Softball, volleyball, brats and burgers -it just doesn\u27t get much better than that. Top it off with a fine mixture of forestry undergraduates, grad students, faculty and staff on a sunny autumn afternoon in Brookside Park and you got the makings for a good time. What better way to kick off the academic year than to mix and mingle, welcome new students, eat a good meal, and take part in some friendly competition

Building and Databases: the SEED Experience

We describe the database requirements of SEED (Software Environment to Support the Early Phases in Building Design). The requirements are typical for a database that intends to support a heterogeneous design support environment consisting of independent software modules with diverse internal design models, requirements not met by any commercial database system. The design and implementation of this database is an integral part of the overall software engineering effort. We describe the SEED approach that integrates external and in-house software based on a shared information model specified in the modeling language SPROUT, which allows for the specification of domains, and classes, relationship types and their behavior, and multiple classifications. The SPROUT run-time system organizes and coordinates the communication between the software modules and the databas

Proton-induced noise in digicons

The Space Telescope, which carries four Digicons, will pass several times per day through a low-altitude portion of the radiation belt called the South Atlantic Anomaly. This is expected to create interference in what is otherwise anticipated to be a noise-free device. Two essential components of the Digicon, the semiconductor diode array and the UV transmitting window, generate noise when subjected to medium-energy proton radiation, a primary component of the belt. These trapped protons, having energies ranging from 2 to 400 Mev and fluences at the Digicon up to 4,000 P+/sec-sq cm, pass through both the window and the diode array, depositing energy in each. In order to evaluate the effect of these protons, engineering test models of Digicon tubes to be flown on the High Resolution Spectrograph were irradiated with low-flux monoenergetic proton beams at the University of Maryland cyclotron. Electron-hole pairs produced by the protons passing through the diodes or the surrounding bulk caused a background count rate. This is the result of holes diffusing over a distance of many diode spacings, causing counts to be triggered simultaneously in the output circuits of several adjacent diodes. Pulse-height spectra of these proton-induced counts indicate that most of the bulk-related counts overlap the single photoelectron peak. A geometrical model will be presented of the charge collection characteristics of the diode array that accounts for most of the observed effects

An Experimental Evaluation of Advanced Rotorcraft Airfoils in the NASA Ames Eleven-foot Transonic Wind Tunnel

Five full scale rotorcraft airfoils were tested in the NASA Ames Eleven-Foot Transonic Wind Tunnel for full scale Reynolds numbers at Mach numbers from 0.3 to 1.07. The models, which spanned the tunnel from floor to ceiling, included two modern baseline airfoils, the SC1095 and SC1094 R8, which have been previously tested in other facilities. Three advanced transonic airfoils, designated the SSC-A09, SSC-A07, and SSC-B08, were tested to confirm predicted performance and provide confirmation of advanced airfoil design methods. The test showed that the eleven-foot tunnel is suited to two-dimensional airfoil testing. Maximum lift coefficients, drag coefficients, pitching moments, and pressure coefficient distributions are presented. The airfoil analysis codes agreed well with the data, with the Grumman GRUMFOIL code giving the best overall performance correlation